While onsite at the American
Psychiatric Association's 168th Annual Meeting in Toronto,
Ontario, Canada, Medscape spoke with Anthony Cannon, MD, a
psychiatrist resident at Northwestern University in Chicago,
about his new study exploring the effects of spiritually and
religiosity on quality of life (QOL) in cancer survivors.[1]

Medscape: What were the objectives of your study?Dr Cannon: We conducted a prospective cohort study of
cancer patients after treatment to determine the relationship of
spirituality and religiosity with patient QOL at 1 year.
The National Cancer Institute defines
spirituality as an individual's sense of peace or purpose and
feelings about the meaning of life in general. Religiosity can be
a conduit for spirituality in the context of specific beliefs and
practices, usually in conjunction with other people who hold the
same beliefs.
On the basis of that construct, an individual can be spiritual,
religious, both, or none.

We compared those with low spirituality/low religiosity, high
spirituality/low religiosity, low spiritually/high religiosity,
and high spirituality/high religiosity. We wanted to see what
effect spirituality and religiosity had on QOL and whether
religiosity worked synergistically or independently.
A total of 551 patients completed an initial questionnaire
(baseline), with the same questionnaire administered at 6- and
12-month follow-up. The patients in our study underwent treatment
for various cancers at an academic medical center between 2006 and
2008. We measured QOL with the Short Form-12 (SF-12), a validated
scale which asks patients to rate various aspects of their
physical and mental QOL.

Medscape: What did your findings reveal about the
relationship between spirituality, religiosity, and QOL?Dr Cannon: In terms of physical QOL, we found that
religious patients had better QOL if they were highly spiritual.
For mental QOL, we found a significant difference between the
extreme groups (low spirituality/low religiosity and high
spirituality/high religiosity), but our findings for mental QOL
had another level of subtlety which raises a question as to what
the role of religiosity is in mental QOL.
For example, among patients who have low levels of religiosity,
patients who are highly spiritual have better mental QOL.
Similarly, among patients who are highly religious, those who were
highly spiritual had better QOL. However, among patients who were
highly spiritual, we failed to detect a significant difference in
mental QOL when comparing patients with high and low levels of
religiosity.

Medscape: To a degree, your findings suggest that
spirituality is more important than religiosity in terms of QOL,
at least in this patient population.Dr Cannon: For mental health, our findings say precisely
that. Spirituality also confers benefits among patients who are
highly religious, helping with physical QOL as well.

Medscape: Can you elaborate on why spirituality vs
religiosity might have contributed to improved QOL in these
patients?Dr Cannon: There are a number of hypotheses as to why
spirituality and not religiosity has a more significant impact on
mental QOL.
One hypothesis could certainly be that some religious beliefs may
view cancer as a punishment from God. Another may be that religion
tends to be more external, and while a religious community may
augment psychosocial support, the religious beliefs themselves may
not translate into a broader understanding of the meaning of their
cancer, or the meaning of their life in general.
Conversely, spirituality tends to be more intrinsic: Peace,
purpose, the meaning of life, and connectedness to others are
concepts that must be considered and understood by each
individual. Therefore, we postulate that the aspects which
constitute heightened spiritual awareness are the ones that
preserve mental QOL because they help individuals cope with and
understand hardship—in this case, a diagnosis of cancer.

Medscape: How might your findings be incorporated into
patient care?Dr Cannon: There's an abundance of emerging evidence
that patients desire spirituality and religiosity to be addressed
and incorporated alongside the medical treatments for their
cancer. Addressing spirituality and religiosity may not change the
way we treat illnesses, but it fundamentally changes the way we
engage patients.
We're not proposing the imposition of a specific spiritual
paradigm or intervention, but rather a genuine exploration with
patients about how they understand their illness and their lives,
and about how that understanding can be enhanced so as to help
each patient live a richer and more fulfilling life despite a
difficult diagnosis and circumstance. The impact of this study is
high because we're adding to the evidence that addressing
spiritual/religious concerns of patients can measurably improve
QOL and is therefore time well spent.
In spite of being able to understand the benefits of spirituality
on QOL, we need to better understand the process of inquiry in
ascertaining the role of spirituality and religion for each
patient. For example, mindfulness meditation has promising data
about improving QOL in medically ill patients, but it may not be a
great fit for all patients. As providers, we need to resist the
urge to say, "You should engage in this specific
practice." Because each patient is different, we must resist the
one-size-fits-all approach in addressing concepts that are so
intrinsic, innate, and personal. Our data suggest that our role as
providers should be to explore with patients and help them
implement interventions that are most likely to be meaningful to
them, rather than prescribing one approach.
Religious/spiritual beliefs can be intensely held and deeply
personal, which is one of the reasons why clinicians are often
reticent to address this with patients; it's a very intimidating,
taboo topic. We're often taught not to talk about religion and
politics. However, genuine curiosity, expressed in a caring,
nonjudgmental, and open-ended fashion, is neither abrasive nor
offensive.

Medscape: But maybe in some cases, especially given your
findings, it's appropriate.Dr Cannon: Yes, I think it's inherently individual.
That's why it should be framed as part of a process of inquiry and
understanding with patients. There are a lot of emerging data to
suggest that patients want these spiritual or religious concerns
addressed concurrently with their medical care. Eighty-four
percent of Americans report a religious affiliation; three
quarters of Americans report a sense of spiritual awareness. And
that proportion grows to 85%-90% among patients who have cancer.[2]
Patients want to discuss spirituality and religiosity. We're
realizing that these conversations can lead to interventions that
profoundly enhance the humanity of our patients, if framed in the
right way and with the right patients.

References

Cannon AJ, Garcia J, Loberiza FR. Interplay between
spirituality and religiosity on the physical and mental
well-being of cancer survivors post-treatment. Program and
abstracts of the 168th American Psychiatric Association
Annual Meeting; May 16-20, 2015; Toronto, Ontario, Canada.
Abstract 63.